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Doctors and patients need to engage in shared decision-making to reduce unnecessary tests and procedures.

A review of a year’s worth of medical research found plenty of examples of doctors ordering unnecessary tests and procedures.

Despite the fact that overuse of medical care is a well-recognized problem, a new study in JAMA Internal Medicine finds some doctors continue to order tests and procedures even when the harm outweighs the benefits.

The study looked at research articles published in 2016 related to medical overuse. Researchers identified what they considered the 10 most influential articles that highlighted evidence of unnecessary care, an issue that costs the healthcare system upward of $200 billion per year.

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The research team found orders for services in which harms may outweigh benefits, such as treatment for early-stage prostate cancer, which they said provides no mortality benefit but increases the risk of erectile dysfunction by 10% to 30%. Likewise, they noted that the most common knee surgery in the U.S. to repair meniscal tears, even with mechanical symptoms, did not improve outcomes in patients.

The researchers highlighted two methods to reduce medical overuse:

Clinician audit and feedback with peer comparison for antibiotic use, which reduced inappropriate use from 20% to 4%

A shared decision-making tool for patients with low-risk chest pain, which reduced emergency room workups from 52% to 37%

“Engaging patients in conversations aimed at shared decision-making and giving practitioners feedback about their performance relative to peers appear to be useful in reducing overuse,” the researchers concluded.

Both doctors and patients can also counteract medical overuse by talking about the risks and side effects of a test or procedure and looking at simpler, safer options, suggests a Consumer Reports article.

“Sometimes medicine gets it wrong, and does too much to the point of harming the patient,” the study’s lead author Daniel J. Morgan, M.D., an associate professor of epidemiology and medicine at the University of Maryland School of Medicine, told the publication. “It’s important for patients to ask questions that make doctors aware they don’t want to err on the side of doing too much.”

A survey of physicians found they blame overtreatment on profit motives, fear of malpractice suits and acceding to patient demands. A study released earlier this year found that hospital-based primary care clinics are more likely to order unnecessary tests and procedures than community-based primary care clinics.